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[Solitary cyst of the calcaneus contemporary diagnostic possibilities: the results and treatment].

Bone remodeling within solitary cyst of the calcaneus has been investigated, its unique location underlined. Different theories behind its origin within the short bone like the calcaneus are discussed. The diagnosis might be supported by magnetic resonance imaging according to Greenfield data. At the final radiographic assessment according to the Neer criteria in majority of the patients incomplete healing with small osteoporotic areas has been found.

Adolescent↗

The use of a pneumatic intermittent impulse compression device in the treatment of calcaneus fractures.

To determine the effects of intermittent compression on foot swelling, intracompartmental pressures, and hospital stay associated with acute calcaneus fractures, we retrospectively reviewed the records of 55 patients between January 1990 and July 1992 whose management profile included preoperative use of an intermittent compression foot pump and surgical treatment by open reduction and internal fixation. Average times were: injury to admission, 6.04 days; admission to surgery, 1.35 days; and surgery to discharge, 3.38 days. Hospital stay averaged 4.73 days. In 27 patients with suspected compartmental ischemia, admission and preoperative pressures in three compartments were averaged and compared: 18.22 and 3.81 mm Hg, respectively (p < 0.001). The authors concluded that the intermittent compression pump appears to rapidly reduce swelling of the foot and decrease elevated compartment pressures associated with calcaneus fractures, which may play a role in decreasing hospital stay.

Bandages↗

Hematogenous osteomyelitis of the calcaneus in children.

Fourteen children (average 9 years) with primary hematogenous osteomyelitis of the calcaneus are reported. Four were seen early and 10 late. Clinical presentation was dramatic, with fever, pain, swelling, and fluctuance around the foot and ankle. The diagnosis was missed initially in 8 cases because the patients were treated for septic arthritis of the ankle, cellulitis, and subcutaneous abscess. The 4 patients seen early healed well, with no complications. The 10 patients seen late had chronic osteomyelitis with growth arrest; shortening of the foot; limb length deficiency; fusion of subtalar, calcaneocuboid, and ankle joints; calcaneus and equinus deformity; avascular necrosis of the talus; and phalangeal loss. Hospital stay was prolonged in 4 patients. Total calcanectomy (3 patients) and talectomy (2 patients) with heel pad preservation were useful salvage procedures avoiding ablation of the limb in chronic cases.

Calcaneus↗

Eleven cases of intraosseous lipoma of the calcaneus.

Intraosseous lipomas are rare benign primary bone tumors, with an incidence of one per thousand bone tumors. We studied eleven cases of intraosseous lipoma of the calcaneus. All the patients received radiographic examinations and MRI with T1-and T2-weighted images with Gd-DTPA enhancement. Seven patients received tumor curettage. Plain radiographs demonstrated that all of the lesions showed clear osteolysis surrounded by a sclerotic margin in the central body of the calcaneus. MRI revealed that all the lesions had demarcated homogenous high signal intensity lesions on both T1- and T2-weighted images, which strongly suggested adipose tissue. In 5 cases, the center of the lesion showed low signal intensity lesions on T1-weighted images, suggesting the existence of central necrosis or cyst formation. After excising the tumors of 7 patients, there was no local tumor recurrence. Surgical intervention was considered unnecessary in all cases after the diagnosis of an intraosseous lipoma was determined by MRI.

Adolescent↗

[Monostotic fibrous dysplasia of the calcaneus: two case reports].

The authors report two unusual cases of aggressive monostotic fibrous dysplasia involving the calcaneus. This lesion occurs on the 2th decade of life. The main symptom is talalgia. On plain films, differential diagnosis includes aggressive cystic or pseudocystic lesions of the calcaneus. On MR imaging, the tumor matrix is more suggestive of the diagnosis. Treatment of this aggressive form of fibrous dysplasia consists of a surgical curettage completed by cryotherapy and graft because of a high level of recurrence.

Adult↗

[Long-term results of treatment for articular calcaneus fractures with Westhues method].

In this paper the authors evaluate the long-term results of treatment for articular calcaneus fractures with Westhues method. This evaluation is performed with regard to triple measurement of Böhler's angle value and to subjective criteria. The clinical material from years 1985-2002 consists of 47 patients aged between 24 and 56 years (mean age 32 years) with articular calcaneus fractures--namely, 41 male patients (87.2%) and 6 female patients (12.8%). The follow-up examination was performed in 24 patients (51% of all patients), namely, in 23 male patients (48.8%) and in one female patient (2.2%). Minimum follow-up time was 12 months and maximum was 9 years. Acquired results suggest that Westhues method restores normal Böhler's angle value only in tongue-type calcaneous fractures.

Adult↗

[Treatment of calcaneus and mid-foot fractures using closed reposition and fixation with the Ilisarov fixator].

Sixteen fractures of the calcaneus involving the subtalar joint were treated by closed reduction and external fixation using the Ilisarov apparatus. Except for four cases in which temporary arthrodesis of the subtalar or ankle joint was used, fixation was usually only used for the calcaneus. The operative technique is described precisely. Initial follow-up examinations (on average after 1 year) show advantages over conservative treatment, e.g. better anatomical reduction. In addition, early mobilization of the joint and early weight-bearing result in less pain from disuse osteoporosis. Furthermore, several case reports demonstrate the efficiency of this method in tarsal and metatarsal fracture-dislocations.

Adult↗

Sexual dimorphism of the calcaneus of South African blacks.

Forensic anthropology is a rapidly growing field in South Africa and skeletal biologists are often called upon by the police to assist in personal identification from skeletal remains, which are recovered in suspected cases of homicide and suicide and in mass disaster. Measurements of the calcaneus have been shown to be sexually dimorphic in South African whites. Since the validity of discriminant function equations in sex determination is population specific, the aim of the present study was to derive similar equations for the calcanei of the South African blacks. The bones that were used in this study were obtained from the Raymond A. Dart Collection of Human Skeletons, School of Anatomical Sciences, University of the Witwatersrand, Johannesburg. One hundred and sixteen (116) intact and non-pathological calcanei, consisting of 58 males and 58 females and belonging to individuals whose age at death ranged between 22 and 75 years, were selected by the simple random sampling technique. The measured variables included the maximum length, the load arm length, the dorsal articular facet length, the body height, the maximum height, the cuboidal facet height, the middle breadth, the dorsal articular facet breadth and the maximum breadth. Discriminant function analyses were done using the Statistical Product and Service Solutions (SPSS) program. All measured parameters of the calcaneus showed significant sexual differences. Length measurements were found to be the most sexually dimorphic. Combinations of variables provided better estimate of sex (79%-86%) than individual variables (64%-79%).

Adult↗

[Pseudarthrosis of a calcaneus fracture: a case report].

Nonunion after a calcaneus fracture is rare. A forty-two-year-old man presented with complaints of extreme left heel pain on weight-bearing, that required him to use crutches. Clinical and radiological studies yielded a diagnosis of calcaneal nonunion. He had a history of an open calcaneal fracture that occurred in a traffic accident eight months before, for which he received cast treatment. He underwent surgical treatment (curettage, bone graft, and internal fixation) for the nonunion of the calcaneus. Eight months after the operation, no problem was observed at the union site, and the patient returned to his normal activity levels. He had a slight heel pain appearing only after walking long distances, which was attributed to the subtalar joint.

Adult↗

[Computerized tomography of intra-articular calcaneus fracture. Comparison: radiomorphologic result--clinical result].

In 55 patients with intraarticular fracture of the calcaneus computed tomography of the fractured bone was performed immediately after the accident and 6-12 months later. We recorded the fracture type according to the classification established by Essex-Lopresti. We evaluated the degree of bony destruction, deformation of the calcaneus and the extent of articular bursting. We recorded the severity of the fracture with reference to a 10-point scale and compared this with the clinical outcome after surgery or conservative therapy. The clinical results were according to a 18-point scale devised by Merle d'Aubigne. Changes between the initial and follow-up CT were also recorded. There was a good correlation between radiological findings and clinical results.

Adolescent↗

Assessment of percutaneous V osteotomy of the calcaneus with Ilizarov application for correction of complex foot deformities.

Complex foot deformity can be described as a foot with multiplanar abnormalities with or without shortening of the foot. Conventional surgical treatment may not be able to correct these deformities. In this study we evaluate the results of percutaneous V osteotomy of the calcaneus with an Ilizarov external fixator for treatment of complex foot deformity. Twenty feet with a complex deformity were treated by the Ilizarov method in 15 patients. The aetiologic factors were neglected or relapsed clubfoot (13 patients) and poliomyelitis (2 patients). All patients underwent percutaneous V osteotomy of the calcaneus and gradual correction of the deformity using Ilizarov's method. The mean duration of fixator application was 9.5 months (range, 6-13 months). The mean follow-up period was 1.8 years (range, 1 to 3 years). At the time of fixator removal, a plantigrade foot was achieved in 18 cases; gait was improved in all patients. There was residual varus deformity in two patients. A pin-tract infection was observed in all patients. No recurrence of the deformity occurred. The V osteotomy offers the most options for correction of complex foot deformities. Percutaneous technique is particularly useful for the complex foot deformity that has poor skin coverage, with poor blood supply. Gradual correction with the Ilizarov method yields good results for complex foot deformities.

Adolescent↗

[Bilateral calcaneus fracture in childhood. A report of experiences].

We report on our treatment of fractures of the calcaneus in childhood. Nearly all cases can be treated by conservative methods with good results as regards both anatomy and function. Occasionally consider operative treatment to be indicated even in childhood. We discuss a rare case of bilateral intraarticular fracture of the calcaneus with severe dislocation of fragments. In this particular case we performed bilateral plate osteosynthesis with good results.

Accidental Falls↗

[The relationship between the calcaneus density and the degree of inflammation in patients with generalized aggressive periodontitis].

PURPOSE: To evaluate the relationship between the calcaneus density and the degree of inflammation in patients with generalized aggressive periodontitis. METHODS: Thirty one volunteers with healthy periodontium (as control group) and 38 patients with generalized aggressive periodontitis (as experimental group) were involved in this study. The average ages of the two groups were 27 and 23 years respectively. The clinical periodontal indexes and panoramic films were measured first. And the broadband ultrasonic attenuation(BUA) and T-score of the calcaneus were then determined using ultrasonic bone densitometer. SAS6.12 software package was used to analyse the data obtained. RESULTS: The BUA values of the two groups were 62.76+/-4.61 and 70.47+/-4.41 respectively, the BUA value of the experimental group was significantly lower than that of the control group (P<0.001). Moreover, T-score was different between the two groups and the score in the experimental group was significantly lower than that in the control (P<0.001). CONCLUSIONS: The BUA and T-score in patients with generalized aggressive periodontitis were significantly lower than that in the controls with healthy periodontium, which indicated that patients with generalized aggressive periodontitis had overall bone density decrease.

Absorptiometry, Photon↗

[Ultrasonic bone mineral density of calcaneus in 1 816 healthy subjects in Guangxi autonomous region].

OBJECTIVE: To study the relationship between ultrasonic bone mineral density (BMD) of calcaneus and age, height, and body weight, and to establish the normal reference value for stiffness index (SI) of healthy subjects in Guangxi autonomous region and provide scientific foundation for the diagnosis and prevention of osteoporosis. METHODS: SI of calcaneus in 1 816 healthy adults aged 11-90 years (775 men, 1 041 women) were measured with quantitative ultrasound. According to their ages, all the men and women were divided into 13 groups by 5-year age group. RESULTS: SI reached peak values in 21-25 year group in men (range: 111.45 +/- 21.19) and in 16-20 year group in women (range: 101.26 +/- 17.51). Then the SI value began to decline with aging. The SI featured by a typical dual-peak curve in women and the decrease rate of SI was faster in women than in men over 61 years. Multivariate linear regression analysis showed significantly negative correlation between SI and age (P < 0.001), positive correlation between SI and body weight (P < 0.05 for men; P < 0.01 for women), and positive correlation between SI and height in women (P < 0.01). CONCLUSION: SI correlates with age, height, and weight. The acquired SI value may provide a reference for the diagnosis of osteoporosis.

Adolescent↗

[Normative data for quantitative ultrasound measurement of the calcaneus in a Portuguese population].

BACKGROUND: Quantitative ultrasound (QUS) measurement of the calcaneus is a safe and reliable method for evaluating skeletal status. Although central bone densitometry (DXA) measurement is the gold-standard to classify osteopenic and osteoporotic patients, QUS can give supplementary information and its use is expanding. Up to now there are no published normative data for QUS measurements in the Portuguese population. OBJECTIVES: The aims of this study were to determine normative QUS data in the Sahara Clinical Sonometer (Hologic) for the Portuguese population. METHODS: Cross-sectional evaluation of consecutive subjects selected as part of the EpiPorto study, Portugal. Calcaneus QUS (Sahara Clinical Sonometer, Hologic) parameters were obtained: Broadband Ultrasound Attenuation (BUA), Speed of Sound (SOS), Quantitative Ultrasound Index (QUI) and Estimated Bone Mineral Density (EBMD) were determined for men and women, stratified by their age group. RESULTS: 1,482 consecutive subjects (1,010 females and 472 males), aged from 18 to 92 years. Higher levels of QUS parameters were found in the lower age group and, for both gender, progressive decrease with age were reported. Men showed higher values as compared to women in all parameters and differences between them increased with age. Differences were significant for BUA after the age of 39 and for SOS after the age of 59. Short-term in vivo precision was 5.5% for BUA and 0.4% for SOS, while in vitro precision was 3.23% for BUA and 0.15% for SOS. DISCUSSION: Our data are comparable to other Southern European data and represent the first QUS normative data for the Portuguese population.

Adolescent↗

[Experience with plating of intra-articular fractures of the calcaneus].

There have been various attempts to improve the results of treatment of fractures of the calcaneus in recent decades. Descriptions of conservative treatment with plaster cast, functional treatment and several methods of closed and open reduction and stabilization have been published. We believe that, especially in young patients, intraarticular fractures with depression of the posterior articular facet should be treated by open anatomical reduction, autologous bone grafting and stabilization with plates. In our clinic 15 fractures of the calcaneus have been treated in this manner in the last few years, and the results are very satisfying.

Adult↗

Computerized tomography scanning of acute intra-articular fractures of the calcaneus. A new classification system.

Computerized tomography was used to evaluate thirty intra-articular fractures of the calcaneus in twenty-seven patients. A classification of the fractures was devised on the basis of fracture patterns involving the posterior facet joint of the calcaneus. In Type I, the fracture fragments were small or not displaced; in Type II, they were displaced; and in Type III, they were comminuted. There were thirteen Type-I, ten Type-II, and seven Type-III fractures, all of which were treated with a variety of closed methods. The length of follow-up ranged from eighteen to fifty-two months (mean, thirty-six months). The results were graded by a predetermined point system that included the evaluation of motion of the subtalar joint. Of the thirteen Type-I fractures, eight had an excellent result; four, a good result; and one, a fair result. Of the ten Type-II fractures, two had a good result; four, a fair result; and four, a poor result. All of the seven Type-III fractures had a poor result. On the basis of our study of the fracture patterns as seen on the computerized tomography scans, we believe that it is possible to predict which fractures will do well with closed treatment and which will not. Type-I fractures did well with closed treatment. Type-II fractures can be treated closed but with a lower success rate than Type-I fractures. All of the Type-III fractures had a poor result after closed treatment.

Adult↗

Avulsion fracture of the calcaneus at the origin of the abductor hallucis muscle.

Previously reported avulsion fractures of the calcaneus have been confined to the attachment of the tendo achillis, bifurcate ligament, extensor digitorum brevis muscle, or the plantar fascia. A case report of a previously undescribed avulsion fracture of the calcaneus due to the abductor hallucis muscle is presented. The mechanism of injury, forced dorsiflexion of the forefoot, is described. A diagnostic and treatment regimen is provided. With appropriate identification of the injury, this unusual calcaneal fracture can be adequately managed.

Adult↗